


<h1 style="line-height:150%"><b><u><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">SAMPLE
DATA<o:p></o:p></span></u></b></h1>

<h1 style="line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif"><o:p>&nbsp;</o:p></span></h1>

<h1 style="line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif"><o:p>&nbsp;</o:p></span></h1>

<h1 style="line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">Processo
n.º <b style="mso-bidi-font-weight:normal"><o:p></o:p></b></span></h1>

<p class="MsoNormal" style="line-height:150%"><span lang="PT-BR" style="font-size:
11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">Denúncia:<b style="mso-bidi-font-weight:normal"> <span style="mso-bidi-font-weight:bold">SUSPENSÃO
CONTRATUAL - DOENÇA OU LESÃO PREEXISTENTE</span><o:p></o:p></b></span></p>

<p class="MsoNormal" style="line-height:150%"><span lang="PT-BR" style="font-size:
11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">Operadora:
<b style="mso-bidi-font-weight:normal"><o:p></o:p></b></span></p>

<p class="MsoNormal" style="line-height:150%"><span lang="PT-BR" style="font-size:
11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">Auto
de Infração:<b style="mso-bidi-font-weight:normal"> 21.261<span style="mso-spacerun:yes">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></b>Emitido em:<b style="mso-bidi-font-weight:
normal"> 23/01/2007<o:p></o:p></b></span></p>

<p class="MsoNormal" style="text-indent:56.7pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:12.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif"><o:p>&nbsp;</o:p></span></p>

<h2 style="line-height:150%"><b style="mso-bidi-font-weight:normal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">RELATÓRIO<o:p></o:p></span></b></h2>

<p class="MsoNormal" style="text-align:justify;line-height:150%"><b style="mso-bidi-font-weight:normal"><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:12.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></b></p>

<p class="MsoNormal" style="text-align:justify;line-height:150%"><b style="mso-bidi-font-weight:normal"><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:12.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></b></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">Trata-se de
processo administrativo que se originou de denúncia dirigida a esta., em face
da operadora </span><b><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
8.5pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;color:black">XXXXX</span></b><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">, inscrita no CNPJ
sob o n.º </span><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
8.5pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;color:black">03.005.217/0001-82</span><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">, por não garantir
a cobertura a cirurgia relativa à Síndrome do Túnel do Carpo (tendinite), sob
alegação de doença ou lesão preexistente (DLP).<o:p></o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:8.5pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;color:black">Nos autos do processo
administrativo a operadora autuada alegou, em sua manifestação, à fl.09, que
não procedeu à devida cobertura tendo em vista tratar-se de uma DLP, estando
então, afastada a cobertura dos eventos abarcados pela Cobertura Parcial
temporária – CPT.<span style="mso-spacerun:yes">&nbsp; </span>Não comprovou nos
autos, porém, o oferecimento dessa opção e nem mesmo de comprovação de tal DLP
antes da negativa de procedimento.</span><b><u><span lang="PT-BR" style="font-family:&quot;Arial&quot;,sans-serif;mso-bidi-font-family:&quot;Times New Roman&quot;"><o:p></o:p></span></u></b></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif">Conseqüentemente,</span><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;font-family:
&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"> oà fl. 25, lavrou o auto de
infração nº, posteriormente considerado nulo, sendo então lavrado, à fl.118, o
auto nº, em 23.01.2007, </span><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">pela
infração ao<span style="mso-bidi-font-style:italic"> </span><i style="mso-bidi-font-style:normal">“artigo 11, Parágrafo Único da Lei 9656/98,
pela constatação da conduta prevista no Artigo 7º, inciso I, da RDC 24/2000,
por suspender a assistência à saúde, ao negar cobertura, em agosto/2001, a
procedimento cirúrgico para correção de Síndrome do Túnel do carpo a M.L.M.S.,
contrato individual/familiar firmado em 27/5/2000, sob alegação de doença
preexistente e sem autorização da ANS.”</i></span><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;font-family:
&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">.<o:p></o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">Notificada sobre o
auto (fls. 117), a demandada apresentou defesa às fls. 120 a 129. Alegou, em
síntese:<o:p></o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoBodyText" style="margin-left:99.55pt;text-indent:-57.0pt;line-height:
150%;mso-list:l0 level1 lfo1;tab-stops:list 99.55pt"><!--[if !supportLists]--><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%"><span style="mso-list:Ignore">-<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><!--[endif]--><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial">A infração restou impossibilitada de ser sancionada
tendo em vista a prescrição trienal ocorrida;<o:p></o:p></span></p>

<p class="MsoBodyText" style="margin-left:99.55pt;text-indent:-57.0pt;line-height:
150%;mso-list:l0 level1 lfo1;tab-stops:list 99.55pt"><!--[if !supportLists]--><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%"><span style="mso-list:Ignore">-<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><!--[endif]--><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial">A empresa, durante o aguardo do julgamento de
recurso administrativo relativo ao Auto de infração que fora considerado nulo,
realizou o procedimento cirúrgico que dera origem à autuação inicial;<o:p></o:p></span></p>

<p class="MsoBodyText" style="margin-left:99.55pt;text-indent:-57.0pt;line-height:
150%;mso-list:l0 level1 lfo1;tab-stops:list 99.55pt"><!--[if !supportLists]--><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%"><span style="mso-list:Ignore">-<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><!--[endif]--><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial">Assim teria se dado a reparação voluntária e
eficaz, de acordo com os termos da RN nº142/06; e<o:p></o:p></span></p>

<p class="MsoBodyText" style="margin-left:99.55pt;text-indent:-57.0pt;line-height:
150%;mso-list:l0 level1 lfo1;tab-stops:list 99.55pt"><!--[if !supportLists]--><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%"><span style="mso-list:Ignore">-<span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><!--[endif]--><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif;
mso-bidi-font-family:Arial">Não desobedecera a legislação já que a vedação
desta é de suspensão do atendimento até a prova da fraude, que se deu nos autos,
pela impossibilidade de evolução da doença no período de 12 meses. Deduziu-se,
por exame médico, que quando da contratação a beneficiária já apresentava a
patologia.<o:p></o:p></span></p>

<p class="MsoBodyText" style="text-indent:42.55pt;line-height:150%"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:10.0pt;line-height:150%;
font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial">É o
relatório.<o:p></o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<p class="MsoNormal"><span lang="PT-BR" style="font-size:11.0pt;mso-bidi-font-size:
12.0pt;font-family:&quot;Verdana&quot;,sans-serif;mso-bidi-font-family:Arial"><o:p>&nbsp;</o:p></span></p>

<h1 style="line-height:150%"><b><u><span lang="PT-BR" style="font-size:11.0pt;
mso-bidi-font-size:10.0pt;line-height:150%;font-family:&quot;Verdana&quot;,sans-serif">SCREENSHOT</span></u></b><strong><span lang="EN" style="mso-ansi-language:EN;font-weight:normal"><o:p></o:p></span></strong></h1>

<p class="MsoNormal"><strong><span lang="EN" style="mso-ansi-language:EN"><o:p>&nbsp;</o:p></span></strong></p>

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<p class="MsoNormal"><strong><span lang="EN" style="mso-ansi-language:EN"><o:p>&nbsp;</o:p></span></strong></p>

<p class="MsoNormal"><strong><span lang="EN" style="mso-ansi-language:EN"><o:p>&nbsp;</o:p></span></strong></p>

<p class="MsoNormal"><span lang="PT-BR"><o:p>&nbsp;</o:p></span></p>


